Healthcare Provider Details

I. General information

NPI: 1760843544
Provider Name (Legal Business Name): DINA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BRISTOL ST STE 100
COSTA MESA CA
92626-5996
US

IV. Provider business mailing address

1401 N TUSTIN AVE STE 225
SANTA ANA CA
92705-8688
US

V. Phone/Fax

Practice location:
  • Phone: 714-850-8408
  • Fax:
Mailing address:
  • Phone: 714-221-6400
  • Fax: 714-221-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: